Glycemic control predicts unfavorable outcome in ischemic stroke

Abstract

Poor glycemic control before stroke occurrence could negatively impact on clinical course after onset and lead to poor neurological and functional outcomes, they say.

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As reported in the journal Stroke, Masahiro Kamouchi (Kyushu University, Fukuoka, Japan) and colleagues analyzed the medical records of 3627 ischemic stroke patients, obtained from the Fukuoka Stroke Registry between June 1999 and August 2010.

The researchers divided the patients into four groups based on their glycated hemoglobin (HbA1c) levels on admission: excellent (HbA1c <6.2%), good (HbA1c 6.2-6.8%), fair (6.9-8.3%), and poor (HbA1c ≥8.4%).

They used the National Institutes of Health Stroke Scale (NIHSS) to measure neurological improvement and deterioration among the different subgroups. Improvement was defined by a decrease of 4 points or more in NIHSS score during hospitalization or a zero NIHSS score at discharge; deterioration was defined as an increase of 1 point or more in NIHSS score.

The team also assessed post-stroke functional impairment, using a modified Rankin Scale (mRS). A poor functional outcome was defined as death (mRS=6) or dependency (mRS=2-5).

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The authors found that neurological improvement significantly decreased and deterioration increased with poorer PSGC status.

After adjustment for age and gender, the likelihood of neurological improvement decreased substantially across the good, fair, and poor PSGC groups, at odds ratios (ORs) of 0.94, 0.72, and 0.53, respectively, as compared with excellent PSGC.

The team also found that the risk for poor functional outcome was higher in patients with poorer PSGC status.

Further analysis revealed that these findings were comparable in patients with noncardioembolic and cardioembolic infarctions, suggesting that the effect of PSGC status on clinical course and outcome is unaffected by stroke subtype, explain the authors.

Commenting on the possible mechanism behind these findings, they suggest that "hyperglycemia itself probably results in neurotoxicity and induces a procoagulant state."

"Additional studies are needed to elucidate whether treatment to provide better glycemic control before onset improves clinical course and outcome in patients with ischemic stroke," they conclude.